Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

702 > Toxicology Week 2 > Flashcards

Toxicology Week 2 Flashcards

1
Q

What toxidrome is seen with TCA overdose?

A

Anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are S/S of anticholinergic toxidrome?

A

Increased BP -> abrupt decrease in BP
Increased HR -> normal to decreased BP
Increased temperature
Rapid decline in mental status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

EKG signs of TCA toxicity

A
  • QRS widening
  • R wave amplitude
    Seizures possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

TCA toxicity treatments

A

Sodium channel blockade reversal***
- Hypertonic sodium
AND/OR
- Alkalinization

Both: sodium bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Goals of sodium bicarb treatment

A
  • QRS narrowing
  • Blood pH <7.55
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do we treat anticholinergic effects of TCA overdose?

A

DONT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are treatments for dysrhythmia in TCA overdose?

A

Magnesium, lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are treatments for hypotension in TCA overdose?

A

Norepinephrine, epinephrine, vasopressin

Last resort: methylene blue, lipid emulsion, high dose insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are treatments for seizures in TCA overdose?

A

Benzodiazepines*, barbiturates

NOT PHENYTOIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why should you not use phenytoin in TCA overdose?

A

Increase frequency and duration of VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why should you not use flumazenil?

A

Blocks benzo, ruins protection against seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are possible TCA decontamination strategies?

A

Orogastric lavage, charcoal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What toxidrome is seen in bupropion overdose?

A

Sympathomimetic (amphetamine backbone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are S/S of a sympathomimetic toxidrome?

A

Increased HR, BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Miscellaneous signs of bupropion toxicity

A
  • Delayed seizures
  • Widened QRS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

T/F: You should avoid sodium bicarbonate in bupropion toxicity

A

TRUE: not responsive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bupropion overdose complications

A
  • Sympathomimetic crisis
  • Lazarus effect
  • Cardiogenic shock
  • Status epilepticus
  • Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Bupropion overdose treatments

A

Decontamination: activated charcoal*

Supportive care: treat BP with benzo*, lipid emulsion? ECMO?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which type of decontamination can be used for severe bupropion overdose or if it’s outside the charcoal window?

A

Whole bowel irrigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

SSRI overdose treatment

A

Supportive care, monitoring
Benzo for BP/tremors

Antidote: cyproheptadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which SSRI is most likely to cause seizures?

A

Citalopram (ECG abnormalities can be delayed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

SSRI overdose S/S?

A

Diaphoresis, hyperthermia, incoordination, spontaneous clonus, agitation, tremor, diarrhea, mental status changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the progression of digoxin toxicity effects?

A

GI effects (N/V, diarrhea)
->
CNS effects (headaches, confusion, delirium, visual halos)
->
Metabolic effects (hyperkalemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are pre-distribution effects of digoxin toxicity?

A
  • N/V
  • Hyperkalemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are post-distribution effects of digoxin toxicity?

A
  • Hypotension
  • Bradycardia
  • Dysrhythmias
  • Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What K should we aim for in hyperkalemia?

A

K < 5 mEq/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What EKG effects are signature of digoxin?

A
  • Prolonged PR interval
  • Salvador Dali’s mustache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Digoxin toxicity treatments

A

Decontamination (activated charcoal - repeat doses in renal failure)

Hyperkalemia treatment (Digoxin immune FAB, calcium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the major concern with calcium treatment in digoxin hyperkalemia treatment?

A

Stone heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which digoxin immune FAB formulation has a higher Vd and less allergies?

A

Fc fraction cleaved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the indications for Digifab?

A
  • K > 5 mEq/L
  • Level > 20 mcg/L
  • Progressing signs of toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the antidysrhythmic of choice without Digifab?

A

Phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do you dose Digifab acutely if you know their dose?

A

1 vial bind 0.5mg of digoxin
cp = dose/Vd
#vials = level * Wt(kg)/100 - round up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How do you dose Digifab acutely if their dose of digoxin was unknown?

A

10 vials for adults AND children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When should Digifab be used for known-dose chronic digoxin toxicity?

A

Post-distribution level of >6 mcg/L
Progressing or severe signs of toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How much Digifab should be given for unknown dose chronic digoxin toxicity?

A

5 vials for adults
3 vials for children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Acute Digifab dosing in clinical practice

A

Give 2 vials and titrate to effect (Q1H without response)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Chronic Digifab dosing in clinical practice

A

Give 1-2 vials and titrate to effect (Q1H without response)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How do you calculate anion gap?

A

Na - (Cl + HCO3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is a normal anion gap?

A

4 - 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Alcohols of interest

A

Methanol
Ethylene Glycol
Isopropanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How do toxic alcohols present?

A
  • Altered mental status
  • GI distress
  • Specific differences between alcohols
43
Q

What are examples of methanols?

A
  • Gas-line antifreeze
  • Windshield washer fluid
  • Denaturants
    (High volatility)
44
Q

What are some examples of ethylene glycol?

A
  • Automobile coolant
  • Solvents
  • De-icers
  • Air conditioning units
    (Low volatility)
45
Q

What are some early signs of toxic alcohols?

A
  • GI distress/inebriation
46
Q

What are the later signs of methanol toxicity?

A
  • High anion gap metabolic acidosis
  • Visual changes
47
Q

What are the later signs of ethylene glycol toxicity?

A
  • High anion gap metabolic acidosis
  • Nephrotoxicity*
  • Hypocalcemia
48
Q

What can we consider for toxic alcohol treatment initially?

A

Decontamination? (activated charcoal, lavage, irrigation)
Electrolytes and ABG
Ethanol level
Methanol and ethylene glycol level - delayed*
Measured osmolality
Consider ADH inhibition

49
Q

What ADH inhibitors we can use?

A

Ethanol
4-methylpyrazole (Fomepizole - Antizol)

50
Q

What is the maintenance goal of ethanol treatment?

A

BAC of 100 mg/dL

51
Q

What are possible side effects of fomepizole?

A

Headache nausea, dizziness, minor allergic reactions

52
Q

How is fomepizole dosed?

A

Loading dose of 15 mg/kg
2nd phase given 10 mg/kg Q12H x4 doses
Maintenance of 15 mg/kg Q12H

53
Q

What substances can be given if the alcohol ingested is unknown?

A
  • Folic acid
  • Thiamine
  • Vitamin B6 (pyradoxime)
  • Magnesium

Shifts metabolic pathway of alcohols

54
Q

What can be given to correct acidosis?

A

Sodium bicarbonate

55
Q

When should hemodialysis be used for toxic alcohols?

A
  • Methanol or ethylene glycol 25-50 mg/dL
  • High osmol gap without another cause
  • End organ manifestations of toxicity
  • Sever metabolic acidosis
56
Q

Levels may be delayed… what can be an early indicator for toxic alcohols?

A

Osmol gap

57
Q

How do you calculate osmol gap?

A

2Na + BUN/2.8 + Glucose/18 + Alcohol/N = calculated osmolality

Osmol gap = measured - calculated
High gap? likely a toxic alcohol

58
Q

What is a normal osmol gap?

A

-14 to 10

59
Q

What should be ruled out during increased anion gap before determining it’s a toxic alcohol?

A
  • Ketones
  • Lactate
  • Worsened renal function
60
Q

What is the “safest” toxic alcohol that we are less worried about?

A

Propylene glycol

61
Q

Isopropyl alcohol

A
  • Very inebriating and irritating
  • GI bleeding possible
  • Metabolized to acetone
62
Q

Which supplement(s) is/are helpful in methanol treatment?

A

Folic acid

63
Q

Which supplement(s) is/are helpful in ethylene glycol treatment?

A

Thiamine, Vitamin B6, Magnesium

64
Q

What are CB1 receptors involved with?

A

CNS
GPCRs
Motor activity
Thinking
Pain perception

65
Q

What are CB2 receptors involved with?

A

Periphery
GPCRs
Immune modulation
Anti-inflammatory

66
Q

What is the major psychoactive component of marijuana?

A

THC (CB1 partial agonism)

67
Q

What lab abnormalities can be caused by synthetic cannabinoids?

A
  • Low potassium
  • Hyperglycemia
  • Increased creatinine kinase*
  • Increased WBC*
  • Increase creatinine*
68
Q

What are common s/s of synthetic cannabinoids?

A
  • Agitation
  • Seizures
  • N/V
  • Dehydration
  • HTN
  • Tachycardia

(Adrenergic)

69
Q

What supportive care can be given to treat agitation in synthetic cannabinoids?

A

IV benzodiazepines

Consider antipsychotics (haloperidol, olanzapine, droperidol)

70
Q

What supportive care can be given to treat seizures in synthetic cannabinoids?

A

IV benzodiazepines

Consider anti-epileptics later on (status epilepticus)

71
Q

What supportive care can be given for dehydration in synthetic cannabinoids?

A

IV crystalloids

72
Q

What supportive care can be given for hypertension/tachycardia in synthetic cannabinoids?

A

IM/IV benzodiazepines first
IV antihypertensives PRN

73
Q

What is the diagnosis criteria for cannabinoids hyperemesis syndrome

A
  • History of regular cannabinoid use
  • Cyclic N/V
  • Generalized, diffuse abdominal pain
  • Compulsive hot showers with symptom improvement
74
Q

What does the pre-emetic (prodromal) phase of CHS look like?

A

Months to years
- Diffuse abdominal discomfort
- Agitation/stress
- Morning nausea, fear of vomiting
- Increased use of marijuana to treat

75
Q

What does the hyper-emetic phase of CHS look like?

A

24-48 hours
- Cyclic episodes of N/V
- Diffuse, severe abdominal pain

76
Q

What does the recovery phase of CHS look like?

A

Upon total cessation of cannabinoids
- Bowel regimes, fluids, electrolyte replacement
- Full resolution may take ~1 months

77
Q

How can CHS be treated?

A
  • Hot showers
  • Capsaicin cream
  • Ondansetron (haloperidol?)
  • Benzodiazepines
  • Supportive care (fluids, electrolytes)
78
Q

What does the sympathomimetic toxidrome look like?

A
  • Increased BP, HR, RR, Temperature
  • Bowel sounds
  • Pupil size increased
  • Diaphoresis
  • Agitated, hyperalert
  • Tremors, seizures
79
Q

How do you treat sympathomimetic toxicity?

A

Elimination (activated charcoal)
IV benzodiazepines
Anti-hypertensives
Fluids
Anti-psychotics
Electrolyte management
Ice baths
Sodium bicarbonate

80
Q

What substances can we look out for in sympathomimetic toxicity?

A
  • Cocaine
  • Amphetamines
  • Bath salts
  • Pseudoephedrine
  • Nootropic
81
Q

How much cocaine is likely to be fatal?

A

1 gram

(1 line is 20-30 mg)

82
Q

What are s/s of cocaine toxicity?

A

Euphoria, seizures, dysrhythmias, HTN
Coronary artery spasm MI?

83
Q

What s/s might indicate cocaine adulteration with levimasole?

A
  • Neutropenia
  • Vasculitis
  • Purpura
84
Q

How is cocaine toxicity treated?

A

Supportive care, benzodiazepines

85
Q

How does amphetamine toxicity present?

A

Agitation, seizures, hyperthermia, HTN, delirium
Similar to cocaine but longer lasting

86
Q

How is amphetamine toxicity treated?

A

Benzodiazepines, barbiturates, anti-hypertensives (supportive care)

87
Q

How does bath salts toxicity present?

A

Agitation, tachycardia, insomnia, paranoia, seizures, violent, unpredictable behavior

88
Q

How is bath salts toxicity treated?

A

Benzodiazepines (clinical effects)
Intubations (airway protection)
Ice packs, cool fluids, antipyretics, benzos (hyperthermia)
Sodium bicarbonate, lidocaine (dysrhythmias)
Fluids (rhabdomyolysis)

89
Q

Why are beta blocker and CCB toxicities more dangerous than other antihypertensives?

A

Hypotension WITH bradycardia

90
Q

What does CCB toxicity look like?

A

Elevated blood sugar

91
Q

What does BB toxicity look like?

A

Decreased mental status

92
Q

What do non-DHP CCBs cause (as opposed to DHPs)?

A

Decreased HR and force of contraction

93
Q

Which BB most commonly causes seizures?

A

Propranolol

94
Q

Which type of BB has more effects?

A

Membrane stabilizing
(Acebutolol, Carvedilol, Betaxolol, Propranolol)

95
Q

Which BB can cause Torsades de Pointes?

A

Sotalol

96
Q

How can you treat CCB/BB toxicity?

A

GI decontamination (AC, WBI)
Fluids (isotonic)
Atropine (0.5-1 mg every 5 min for 3 doses, increases HR)
Calcium IV
Glucagon?
High-dose insulin and glucose**

97
Q

How should high dose insulin euglycemia (HIET) therapy be given?

A

1 U/kg bolus, then 1-10 U/kg/hr
Keep glucose >100 mg/dL
Replace potassium as needed (2.8 - 3.5)
May take 30-60 min to work

98
Q

When should you use glucagon and what can you expect?

A

It can be helpful after BB, given 3-5 mg and causes vomiting (avoid with altered mental status)

99
Q

Which is the more potent form of calcium?

A

Calcium chloride is 3x more potent than calcium gluconate and causes sclerosing

100
Q

What is the differential diagnostic lab that can point out CCBs?

A

Glucose (Ca2+ affects pancreas, less insulin)

101
Q

What are adjunct treatments we can use for BB/CCBs?

A

Vasopressors (NE/EPI)
Inotropes (dobutamine, milrinone)
Cardiac pacing
Intralipid
VA-ECMO

102
Q

What can we use to treat overdose of other antihypertensives?

A

Fluids*
Vasopressors
Atropine

103
Q

What is special about clonidine toxicity presentation?

A

Transient HTN* and tachycardia* followed by an ABRUPT change to hypotension and bradycardia
- CNS and respiratory depression

104
Q

How can we treat clonidine toxicity?

A

Naloxone 5-10 mg bolus +/- infusion (opioid receptor respiratory depression)
Supportive care

702 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions